Are Day Hospitals Effective for Acutely Ill Psychiatric Patients? A European Multicenter Randomized Controlled Trial

Thomas W. Kallert, Prof. Dr.; Stefan Priebe, Prof. Dr.; Rosemarie McCabe, Ph.D.; Andrzej Kiejna, Prof. Dr.; Joanna Rymaszewska, Dr. hab.; Petr Nawka, M.U.Dr.; Ladislav Ocvár; Jirí Raboch, Prof. Dr.; Lucie Stárková-Kalisová, Dr.; Rainer Koch, Prof. Dr.; and Matthias Schützwohl, Dr.

Objective: Acute psychiatric day care has been proposed as an alternative to conventional inpatient care, yet the evidence of its effectiveness is inconsistent and based only on single-site studies in 3 countries. The aim of this multicenter randomized controlled trial was to establish the effectiveness of acute day hospital care in a large sample across a range of mental health care systems.

Method: The trial was conducted from December 2000 to September 2003 in 5 European countries, with a sample of 1117 voluntarily admitted patients. Immediately before or very shortly after admission to the participating psychiatric facilities, patients were randomly allocated to treatment in a day hospital or an inpatient ward. Psychopathology, treatment satisfaction, subjective quality of life, and social disabilities were assessed at admission, at discharge, and 3 and 12 months after discharge. An intention-to-treat analysis was conducted using fixed-effects linear models with structured error covariance matrices and covariates.

Results: Day hospital care was as effective as conventional inpatient care with respect to psychopathologic symptoms, treatment satisfaction, and quality of life. It was more effective on social functioning at discharge and at the 3- and 12-month follow-up assessments.

Conclusion: This study, which has more than doubled the existing evidence base, has shown that day hospital care is as effective on clinical outcomes as conventional inpatient care and more effective on social outcomes.

Clinical Trials Registration: ClinicalTrials.gov identifier NCT00153959.

(J Clin Psychiatry 2007;68:278-287)

Received April 26, 2006; accepted Oct. 10, 2006. From the Department of Psychiatry and Psychotherapy, University Hospital (Drs. Kallert and Schützwohl) and the Institute of Medical Information Technology and Biometrics (Dr. Koch), Dresden University of Technology, Dresden, Germany; Unit for Social and Community Psychiatry, Barts' and The London School of Medicine, London, United Kingdom (Drs. Priebe and McCabe); Department of Psychiatry, Wroclaw University of Medicine, Wroclaw, Poland (Drs. Kiejna and Rymaszewska); Michalovce Psychiatric Hospital, Michalovce, Slovak Republic (Dr. Nawka and Mr. Oãvár); and Department of Psychiatry, First Medical Faculty, Charles University of Prague, Prague, Czech Republic (Drs. Raboch and Stárková-Kaliová).

EDEN (Psychiatric Day Hospital Treatment: An Alternative to Inpatient Treatment, Being Cost-Effective and Minimizing Post-Treatment Needs for Care? An Evaluative Study in European Countries With Different Care Systems) was funded by the European Commission (Quality of Life and Management of Living Resources Programme: QLG4-CT-2000-01700). Additional national grants supporting the project were provided by Roland-Ernst-Stiftung für Gesundheitswesen [Roland Ernst Foundation for Health Services] and the Faculty of Medicine at the Dresden University of Technology, the National Health Service Executive Organization and Management Programme (United Kingdom), the Polish National Committee of Scientific Affairs, and the Slovak Ministry of Education. Pfizer Pharmaceutical Co. supported travel and accommodation for EDEN project meetings.

The authors report no additional financial or other relationship relevant to the subject of this article.

Acknowledgments are listed at the end of the article.

Corresponding author and reprints: Thomas W. Kallert, Prof. Dr., Dresden University of Technology, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Fetscherstraße 74, D-01307 Dresden, Germany (e-mail: thomas.kallert@mailbox.tu-dresden.de).